Wally,
I would get a second opinion. I would want to know about my biopsy before deciding whether to pursue radiation or surgery. In my case, Gleason was 7 (4+3) and cancer was shown on 2 of 12 samples. I opted for surgerylast August.
Bll

Do you mean a second opinion from another radiologist? My urologist has already recommended surgery. These guys don't seem to talk to each other.
If Gleason 7 (4+3) and cancer on 2 of 12 samples made you think surgery,
what might be the surgery point for Gleason 3+4? The same 2 points?.
Another problem is that all this takes so much time, and I feel it is so urgent to do somehing.

I hope your surgery went well. How long before you could do fairly normal activities?

The first number in the Gleason is the worst cell pattern in the sample and the second is the most common cell pattern in the same sample. A 3+4 means the most common pattern is a 3 so that is better than a 4+3 where the most common pattern is a 4 (out of 5). I thought you meant that the urologist suggested only radiation therapy and then you should get a second opinion to consider surgery as well. I had a biopsy in 2010 where there was no cancer in any of the 12 samples but one of the samples had an abnormal cell pattern called a PIN (prostatic intraepithelial neuroplasia). Then, 2 years later, 2 of 12 showed cancer. Both my older and younger brothers also had prostate cancer before me so it was clear that this was going to get worse, not better and my PSA doubled from 4 to 8 in 2 years. I wanted to get it out and my doctor used the Da Vinci robot for surgery.

Your Gleason 6 is on the low side so your timing is not critical but with cancer present, it will only get worse. I would not dally but would not let the urgency push you into a bad decision.

With regard to returning to normal activities, a catheter is in for 2 weeks. One month after surgery, you can get back to normal but I would not do activities that require a lot of effort. The internal stitches dissolve in 10 days and I would wait for a month after that to let the internal wound heal. It is uncomfortable to sit on a hard seat for about 2-3 months and this is an indication that the internals are still swelled and care should be exercised.

My surgery was in August and I hired somebody to handle fall leaves but I am ready to do yard work this spring.

Bill

__________________Bill

Last edited by Billy6; 03-18-2013 at 03:31 AM.
Reason: Had the 3+4 and 4+3 numbers reversed. Thanks, Alinur

I'm a 7, not a 6. I don't know if it is 4+3 or 3+4. I suppose I could find out. But I'm not sure how that would influence my decision, one way or the other.

I found out that seed therapy for 7's is not covered by my govt health insurance, unless they have only recently extended the coverage. That makes me wonder if the brachy for 7's is a little experimental,

Your personal comments post-surgery are very, very useful to me. If you don't mind, may I ask if you have any problems with incontinence?

It's terrific to talk to someone like you about this. I have read a lot, in a short time, but the personal contact is great.
My thanks.

Incontinence is temporary problem. The problem is a physical one. The surgery removes the prostate but also one of the two sphincters, the one at the bladder. The one below the prostate is intact but that is the only impediment to urine flow now. When the catheter is in for 2 weeks, there is a thing about 1/3 inch in diameter through that sphincter. It is a muscle that wants to be closed but it can't close. When it is removed, the sphincter can close but it is weak and leaks. This happens when the abdominal muscles are exercised, lke standing up, coughing, walking, stooping. You need to wear pads for this. They come in 1-star to 5-star types. 5-stars are large and thick. They hold a lot of liquid, they do not leak and they have no odor. 4-star is large but thinner. 3-stars are smaller and thick. 2-stars are smaller and thin. 1-star is even smaller and thin. Beyond that, there are panty liners. I wish they would change the name, let's call them PLs. They are very thin and about 1 1/2 inch wide.

After my surgery, we had a 2 week vacation planned at the point 23 days after surgery and the doctor said that was OK. We drove about 700 miles (sitting on a pillow and stopping every 2 hours), then walked around some parks. I needed to change pads maybe 3 times a day. At 30 days post-surgery, I walked for 7 hours straight in New York City. There was a squirt every 30 to 50 steps and had to change pads once in that time.

By 2 months after surgery, I was down to 3-star and, by 5 months, down to 1-star or PLs, depending on the daily activity.

It is an inconvenience but it is livable and temporary so not a big problem.

You should obtain Dr. Walsh's book, "Guide to Surviving Prostate Cancer". It is about $10 from Amazon. It discusses issues leading up to treatment, the treatment itself and post-treatment issues.

Thank you for your very frank and very useful reply. You have been very fortunate in how your surgery went. I wish I could be sure it'd go the same for me.

My difficulty is this. I keep reading that seed brachy is good only for GL up to 6.
But I have an impressive and well-qualified oncologist telling me he is now having excellent results using it for 7 (3 + 4), and with fewer incidents of serious side-effects. I worry that it is all still a bit experimental. But then again, maybe it is the way of the future!

Every day I wake up with my mind made up. But not in the same way as the day before!

Your oncologist is steering you right. Brachytherapy is commonly used, not experimental, for gleason 7 with good results. Google "brachytherapy for gleason 7". The implant pattern can be tailored to the prostate and provide high doses a few millimeters beyond the edge of the prostate.

Pre-brachytherapy PSA 4.4 and Gleason 6. I had the seed implant on June 6, 2012 at the age of 73. Catheter was removed as I was waking from the anesthesia. No incontinence at all. No pads. Everything working good. Two days after the implant we did a 2300 mile road trip home. Again, no issues. My last PSA was 0.3 and still dropping. Couldn't be happier.

Bharlan, Thank you. That's so encouraging.Why did you have to drive so far? Is it only done in a few places in the USA? How many seeds? Could you feel this radiation process happening inside you over the months? Did you feel any pain? How long to get back to your normal level of vitality?

We live in Arkansas. I chose Dr. Peter Grimm in Seattle for the implant. I was concerned there might be significant urgency immediately after the implant and didn't want to risk the toilets being occupied on an aircraft. Besides we enjoy long road trips anyway. My wife insisted on driving the first few hundred miles. I sat on a donut and was fine riding or driving.

Brachytherapy is widely done in the U.S. Could have had it done in Jonesboro where we live but preferred to go to an expert in the field. If you are old enough to have medicare and have a good medigap insurance policy you can go wherever you choose. Our out-of-pocket expenses have only been for travel.

24 needles. 72 seeds. Prostate volume was 20cc.

Could not feel the radiation.

The only pain was during the first few urinations also with a small amount of blood. After the first day the urination pain and blood were essentially gone.

Vitality was back to normal after 2 or 3 days. You still need to take it easy for a few days and no bike, horseback, hard tractor seat riding for several weeks. Also no young children or pregnant women sitting on your lap for a few months.

I have been reading this thread with great interest, all I can say is that I was diagnosed with Gleason 7 (4+3) and the scans indicated that "Tendrills" had left the Prostate Capsule. So I could not have RP and Brachytherapy was suggested with the assurance that when "Mapping" of the seed implantant was established, that seeds would be placed outside the capsule to cover the tendrils.

I also had a course of Hormone injections ( Prostap) and had a course of Radio therapy 26 sessions. Now I am 18months post implantation of 68 seeds into the prostate and have had PSA tests every three months they read 00.01, 00.01, 00.02,00.01,00.01,00. These tests in my view seal the case that Brachy therapy works.

The hospital where I had the procedure done have records of 18 year (survival patients) of 97%. So I am a great one for recommending the procedure without hesitation, However, you must find a consultant Urologist who works with an Oncologist, and are experienced in the placement of the seeds. Because you must have them mapped, and placed as per the mapping.

I am well now, and have no Prostate worries, I hope you have the same, but only you can decide on which procedure you have.

LDR Brachy monotherapy is a good choice for intermediate risk, but results I've seen published vary widely according to who is doing the seed placement. Drs like Grimm have great track records with it, others do not. It seems to have a steep learning curve. I'm not familiar with any famous brachytherapists in Toronto -- not to say there aren't any, I'm just not aware of any.

I do know that Sunnybrook has some very good ROs, and I know that Patrick Cheung there does SBRT. Maybe you can get a referral for brachy from someone there. BTW, HDR brachy monotherapy and SBRT have excellent cure rates and very low side effect profiles for intermediate risk treatment, and may not have so steep a learning curve.